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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by maurorless on March 10, 2018, at 16:41:43
Hi,
I am suffering from 'I don't care', 'I hate myself', etc etc etc depression and some type of anxiety that keeps me in the house though I do like people and like to talk to them when I can drag myself out of the house. I really don't care; take a shower? wash my face at night--haha, eat something that requires effort? and I have dogs who are suffering from severe lack of attention. As a caveat, I also have some major health problems and no support. I don't know what to do so I am asking for some input from anyone who might read this post.
I'm on generic Wellbutrin 450mg and 40mg prozac. Not working. The wellbutrin worked like a true miracle for about four weeks and then began to fade away. I've kept taking it--tough to find a psychiatrist in my city (so I could talk to someone about other meds) who takes medicare (about 15%) though I have complete BC/BS coverage. I also don't have much money.Zoloft and prozac have been suggested. My family practice dr will prescribe most psych meds I ask for, very understanding dr.
The conundrum is that I have liver (NASH) problems, not from drinking, and Chronic Kidney Disease and both zoloft and wellbutrin can cause problems if the dosage is too high, though I haven't read what "too high" maybe. If one can take "x" amount of Zoloft (make up number 400mg) is 200 mg then considered a lower dose
Thank you
Posted by Lamdage22 on March 11, 2018, at 6:32:58
In reply to Best meds for 'I don't care anymore' sydrome, posted by maurorless on March 10, 2018, at 16:41:43
I wouldnt place my bet on medication only with this issue. There is no drugs approved for "i dont care"...
Posted by SLS on March 11, 2018, at 8:31:25
In reply to Re: Best meds for 'I don't care anymore' sydrome, posted by Lamdage22 on March 11, 2018, at 6:32:58
> I wouldnt place my bet on medication only with this issue. There is no drugs approved for "i dont care"...
With some cases of depression, "loss of interest" is the prominent symptom. I am more disinterested and lacking in motivation than I am sad. I found that Nardil - when it worked for me - was the best drug for these symptoms. Parnate is not as effective for me. I found Effexor to be pretty good. For some people, the right SSRI can produce full remission. However, amotivation and apathy can be side effects. I really don't see this with the SNRIs. Of the tricyclics, I would suggest nortriptyline or imipramine as alternatives. Imipramine carries with it more pronounced anticholinergic side effects, so nortriptyline is the drug I would try first. If you want, you can take a test that shows your levels of C-reactive protein (CRP). This is a biomarker for inflammation, and can predict which antidedpressants you have a better chance of responding to. High levels predict a better response to nortriptyline. Low levels predict a better response to Lexapro. I don't know if this extends to other serotonin reuptake inhibitors, though.
As Lamdage suggests, your lack of interested could be due to psychosocial factors rather than biological ones. It might be worth discussing this with a psychiatrist or psychologist if drugs don't help.
How is your energy level? Wellbutrin can help with this. Even if it does, it may not help with lack of interest. However, Wellbutrin can work well when combined with a SSRI or SNRI to hit both energy and interest deficits.
- Scott
Posted by bleauberry on March 12, 2018, at 15:57:41
In reply to Best meds for 'I don't care anymore' sydrome, posted by maurorless on March 10, 2018, at 16:41:43
Ritalin 10mg every 3 hours or 20mg 3 times a day. Nothing else needed.
The hard part will be the transition. You will have withdrawals getting off of either Wellbutrin or Prozac and they can last for weeks, even a couple months.
Maybe drop Wellbutrin, keep Prozac, start Ritalin at a low dose - maybe 5mg t.i.d. - and ramp up to full dose over several weeks - then start trying to wean off of Prozac slowly, by simply skipping doses - skip a day - after a while start skipping 2 days - you can also mix the Prozac contents of the capsule into juice and drink a custom sized dose - 20mg in juice, drink 1/4 of it, that is a 5mg dose, and the rest of it stays good in the fridge for about a week. Prozac half-life is a week, very long, which is why you can skip doses and get away with it.
A major problem with all of the antidepressants is their strong tendency to numb out your emotions so you just don't feel much.
While Ritalin is a stimulant, it makes a really good antidepressant after a few weeks of titrating onto it. It can make you interested in the world again, it makes you feel calm and you sleep better.
If your complaint is emotional numbness and a lack of desire to do anything then I would suggest staying far away from antidepressants. Or if you feel you want them or need them, stay with low doses.
To get out of the rut you need more active dopamine and norepinephrine and not from a re-uptake mechanism.
The herb Rhodiola Rosea is also an excellent candidate for you. It works better as an antidepressant and anti-anxiety than any meds I ever tried. It can have an effect almost immediate, which fades, but the real effect comes on slowly over weeks and months, and continues to get better the longer you take it.
I battled anhedonia and lack of motivation for decades. I didn't realize during that time that it was my meds causing most of the problems. Without meds I still have some 'procrastination', but way more functional and in the world.
The thing that got me better after 20 years of psychiatry was meds and herbs for Lyme disease instead, which totally obliterated the depression, schizo-affective, and bipolar stuff. Gone. Totally gone. It was microscopic monsters in my brain the whole time. Based on what my doctors told me, 9 out of 10 people here at this site also have monsters in their brains.
Posted by PeterMartin on March 13, 2018, at 13:08:51
In reply to Re: Best meds for 'I don't care anymore' sydrome » maurorless, posted by bleauberry on March 12, 2018, at 15:57:41
For an antidepressant I agree that an Maoi like Nardil is the most likely to help your depression. Itd probably be difficult to get a GP to prescribe Nardik or Parnat since there are minor dietary restriction & some interactions.
The other issue with going to an MAOI is that since you are on Prozac, which has an incrediblely long half life, you'd probably need to be off of that for at least a month before beginning Nardil or Parnate.
Lamictal would be a random suggestion. It's a different class of meds (technically a mood stabilizer) but it always keeps my head afloat. Can take it w an Maoi as I do.
I agree Nardil may help w motivating you and may help depression. Problem w Ritalin forme at least is tolerance and I can get a little abusive w taking more than I'm supposed to. It's a controlled substance so you may have to see your doctor monthly or at least fairly frequently to get refills.
Posted by PeterMartin on March 13, 2018, at 13:10:15
In reply to Re: Best meds for 'I don't care anymore' sydrome, posted by PeterMartin on March 13, 2018, at 13:08:51
Sorry my last paragraph there was about Ritalin. I need to stop writing posts on my old laggy phone.
Good luck.
Posted by SLS on March 13, 2018, at 15:49:32
In reply to Re: Best meds for 'I don't care anymore' sydrome » maurorless, posted by bleauberry on March 12, 2018, at 15:57:41
Bleauberry, you seem to have a talent for using words to persuade people of things. This is a gift.
> Ritalin 10mg every 3 hours or 20mg 3 times a day. Nothing else needed.
So, it is your suggestion to Maurorless that he or she discontinue all current medications and take only Ritalin? You are certain enough of this such that you can guarantee Maurorless that doing so will not result in a deterioration and worsening of depression? I find your posture of surety troubling. I would also point out that you often contradict yourself - even within the same post. "Nothing else needed" does not mean continuing to experiment with additional substances. I am also troubled by your continued supposition that whatever works for you will work for everyone else, and that one recipe fits all.
> If your complaint is emotional numbness and a lack of desire to do anything then I would suggest staying far away from antidepressants.
Would that be all antidepressants or just some in particular? Emotional numbness and a lack of desire to do things can be the manifestations of a vegetative state or deficit syndrome; things that antidepressants and combination treatments can address effectively. I suggest that people do NOT stay far away from antidepressants when trying to address anergia, anhedonia, loss of interest, amotivation, or flat affect. To stay away from something means to deny it from consideration. Again, I would caution against providing a one-size-fits-all recipe for treatment, or suggesting things in a manner that imply having certainty in the understanding of psychobiology and predicting treatment outcomes. I, myself, have no such certainty despite my researching biological psychiatry since 1983. Of course, I might not be smart enough. Actually, I am certain that I am not smart enough. With each new scientific finding that is announced, 10 or more theories are disproved while 10 or more new theories emerge.
I am both saddened and amused that some people still think that SSRIs work to treat depression by blunting emotions. While apathy and amotivation can emerge as side effects, this is not a universal occurrence.
I will follow the progress of the people who take your advice. I expect to see some people respond favorably to some of the herbs, vitamins, and supplements you suggest. I am curious to see which herbal preparations display medicinal properties. There are several that interest me. I also expect to see some treatment failures. I guess the question becomes, what treatment paths have the best chances for success when confronting severe mood and anxiety disorders.
- Scott
Posted by Lamdage22 on March 15, 2018, at 1:59:21
In reply to Re: Best meds for 'I don't care anymore' sydrome » bleauberry, posted by SLS on March 13, 2018, at 15:49:32
bleauberry,
what do you think about low dose naltrexone? It is supposed to boost killer cells by the mechanism of increased endorphines.
Posted by bleauberry on March 22, 2018, at 7:48:35
In reply to Re: Best meds for 'I don't care anymore' sydrome » bleauberry, posted by SLS on March 13, 2018, at 15:49:32
>
> So, it is your suggestion to Maurorless that he or she discontinue all current medications and take only Ritalin?NO!!! I never said that. It is, or should be, a universal understanding with all patients that you talk to your doctor about changing meds or doses.
>You are certain enough of this such that you can guarantee Maurorless that doing so will not result in a deterioration and worsening of depression?
NO!!! I never said that either. I can't promise any more than the you or a psychiatrist can. I am, however, quite certain that Ritalin is a widely prescribed medication for a reason - it helps more people with more symptoms than just about any other meds out there - mood, energy, motivation, focus, enjoyment of hobbies.
>I find your posture of surety troubling.
My posture got me well and got other people well, when the doctors were not performing well. I don't see how that should be troubling to anybody.>I would also point out that you often contradict yourself - even within the same post. "Nothing else needed" does not mean continuing to experiment with additional substances. I am also troubled by your continued supposition that whatever works for you will work for everyone else, and that one recipe fits all.
SLS I am troubled by patients being poorly mismanaged by their doctors. There are patients who have been guinnea pigs for 10 years, 20 years,30 years, who are not much improved today than they were long ago. THAT is troublesome. I help people out of that dungeon. I give them a 'posture' and a 'perspective' that is new to them. Because the posture they currently have, is failing, is old, is outdated, and failing for a long time. imo
> Would that be all antidepressants or just some in particular? Emotional numbness and a lack of desire to do things can be the manifestations of a vegetative state or deficit syndrome; things that antidepressants and combination treatments can address effectively. I suggest that people do NOT stay far away from antidepressants when trying to address anergia, anhedonia, loss of interest, amotivation, or flat affect. To stay away from something means to deny it from consideration. Again, I would caution against providing a one-size-fits-all recipe for treatment, or suggesting things in a manner that imply having certainty in the understanding of psychobiology and predicting treatment outcomes. I, myself, have no such certainty despite my researching biological psychiatry since 1983. Of course, I might not be smart enough. Actually, I am certain that I am not smart enough. With each new scientific finding that is announced, 10 or more theories are disproved while 10 or more new theories emerge.The problem is that personal bias causes some people to pick and choose which new things they embrace or trash. For example, that lyme complications are profoundly tied to psychiatry is a fairly new discovery by LLMDs - last 10 years or so - and despite so many profound success stories, such as mine, some patients will choose to ignore it simply because it doesn't jive with their own world view.
Tricyclics and SSRIs routinely cause anhedonia and blunting where those symptoms did not previously exist. It is a primary complaint of most psych patients. Emotional numbness is NOT a symptom most patients complain about when they enter treatment - but it is a common one when they are in treatment. And it doesn't matter which antidepressant it is. The two exceptions may be Nardil and Parnate. Sometimes people don't get blunting. That is not frequent.
>
> I am both saddened and amused that some people still think that SSRIs work to treat depression by blunting emotions. While apathy and amotivation can emerge as side effects, this is not a universal occurrence.Close. Maybe not universal. But close. It is one of the primary complaints and topics of discussion at this board going back decades. Patients don't have those complaints until after they are on meds. The fact that DA and NE receptor sites soak up excess serotonin from SSRIs might have something to do with it. But even just pure NE can blunt too. I have experienced that. I am not sure what the science is to explain that one. I have a hypothesis though. That is, that when there are excess neurotransmitters via the reuptake blocking mechanism, maybe with some people their feedback loops are not working properly, so the firing of new neurotransmitters slows way way down - the synapses just sit in a stagnant pool without much firing or activity happening - remission happens when the firing resumes with the increased pool - but often that doesn't develop. In a pool of neurotransmitters via stopping reuptake, synapses experience very little firing or activity, and thus blunting. Hypothesis.
>
> I will follow the progress of the people who take your advice. I expect to see some people respond favorably to some of the herbs, vitamins, and supplements you suggest. I am curious to see which herbal preparations display medicinal properties.There won't be any people here openly following my advice so tracking that is not going to work very well. If you are truly curious of medicinal properties of herbs then you would do yourself a monumental favor by reading the book Healing Lyme by Stephen Buhner. Much of the book is in medical/scientific jargon with pages and pages of references and clinical studies on each and every herb discussed. That book - before you go ridicule it - is THE book that ended my 20 years of treatment resistant depression. It is on the bookshelf of both of my doctors. Any patient truly wanting to get better would read it. 9 out of 10 patients entering my doctor's office are also significantly improved in rapid time with their psychiatric symptoms that have been poorly managed by other doctors for years - in their own words, not mine.
Another great book - more medical/prescription instead of herbal, is called Why Can't I Get Better, Horowitz.
>There are several that interest me. I also expect to see some treatment failures. I guess the question becomes, what treatment paths have the best chances for success when confronting severe mood and anxiety disorders.
It's a different game. You don't take a pill and wait 6 weeks. You take a variety of pills that address microbial insults, systemic inflammation, brain inflammation, hormonal rejuvenation and balance, and toxin removal. None of them are specific for psychiatry. Those things combined, sort of like an orchestra, provide real potential for significant gains in quality of life, most especially in the realm of psychiatry, despite they aren't considered psychiatric herbs, compared to failed meds. Again, my two doctor's own words, not mine. My journey definitely confirms, however.
I just wish people would understand that what is wrong in their head is most likely coming from the body not the head.
And I wish they would understand that psychiatry can be amazingly helpful for short term or acute situations, but should maybe generally be toned down for longterm or chronic situations, which could likely produce better results through a totally different approach.
imo = in my opinion = something I always say = nothing is definite
This is the end of the thread.
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